Emotionally Drained

Today was not a fun day.

When we arrived at the hospital, Andrew was awake, alert, and peaceful. He looked very cute and very curious, staring intently at his mobile, then at our faces after we arrived. He held my finger and stared at me for a long time, with a lot of personality in his face. The nurse told us that he had just calmed down after two hours of crying, fussiness, and general distress...blood pressure up, oxygenation down. He was good for a long while, then he got fussy again. Eventually he got into a pattern where he would go nuts every ten minutes or so, attempting to scream, flailing his legs and arms, and turning red. He'd calm down temporarily, then start the whole process over again. For the most part, his numbers were all reacting in a healthy manner...they dropped, but rebounded pretty well when he was done...the nurses also gave him a little more oxygen when he was in the middle of a tantrum.

If this process had happened once or twice, it would have been okay. Unfortunately, it happened many times. They had given him three doses of Ativan and three doses of morphine, though they had mostly weaned him off of both. The drugs didn't seem to be giving him a whole lot of comfort, though eventually the morphine took the edge off. In addition, he vomited a few times, prompting them to readjust his NG tube so they'd get better suction. That worked, but then the tube was full of saliva and bile...these incidents just served to reinforce the fact that he definitely has an intestinal blockage.

With his additional distress, the doctors became a little more concerned. They called the surgeon for a consult, and spent a lot of time with him to make sure nothing was seriously wrong. Fortunately, their examinations didn't suggest that he has an emergent condition, and they are content to wait until the appropriate time for his surgery. After talking to all of them, I felt quite a bit better. Some of the scarier possibilities are very unlikely, Andrew's physical examination showed none of the warning signs (distended belly, low pH, lack of bowel sounds, etc), and he wasn't demonstrating what the surgeon called "surgery pain." Apparently, when there's an obstruction of the bowel that causes a disruption of blood flow, it doesn't matter how much morphine he's had...a push on his tummy would make him jump off the bed in pain. It's obvious that Andrew's belly is causing him a bit of pain, but he's closer to a normal baby with colic than he is to an emergency case.

The surgery is currently scheduled for Friday morning at 8:30. Until then, they will keep a close eye on him for any signs that he is having additional problems. They'll give him additional blood tests (they were down to every eight hours, instead of four), they'll examine his belly repeatedly, and they'll give him as much morphine as he needs to keep him comfortable from any tummyache. If anything looks out of the ordinary, they'll get him immediately to the operating room and get it taken care of....otherwise, Friday morning will be optimal. On Friday, a fully-prepared OR and two senior surgeons will be available for Andrew's operation.

More about the actual surgery later, but rest assured that Andrew is in very good hands, both with the doctors and nurses keeping an eye on him now, and with the surgeons doing the operation on Friday. Obviously we would rather keep scalpels away from him for the rest of his life, but this was a not-unexpected surgery and it will be good to get it out of the way. I am no more nervous for this than I would be for any surgery on my child, and I think it will solve problems rather than causing any further ones. When it's done, I hope Andrew's digestive progress will quickly be on par with his ventilator progress, which has been fabulous. They have paused all his settings in preparation for the surgery, but his numbers would ordinarily be weanable.